Healthcare Provider Details

I. General information

NPI: 1306063920
Provider Name (Legal Business Name): EVA ILLSE RUBIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE. ML 5031
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE. ML 5021
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4251
  • Fax: 513-636-8145
Mailing address:
  • Phone: 513-636-5582
  • Fax: 866-823-7996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD428881
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: